Glycemic management in ESRD and earlier stages of CKD

Mark E. Williams, Rajesh Garg

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


The management of hyperglycemia in patients with kidney failure is complex, and the goals and methods regarding glycemic control in chronic kidney disease (CKD) are not clearly defined. Although aggressive glycemic control seems to be advantageous in early diabetic nephropathy, outcome data supporting tight glycemic control in patients with advanced CKD (including end-stage renal disease [ESRD]) are lacking. Challenges in the management of such patients include therapeutic inertia, monitoring difficulties, and the complexity of available treatments. In this article, we review the alterations in glucose homeostasis that occur in kidney failure, current views on the value of glycemic control and issues with its determination, and more recent approaches to monitor or measure glycemic control. Hypoglycemia and treatment options for patients with diabetes and ESRD or earlier stages of CKD also are addressed, discussing the insulin and noninsulin agents that currently are available, along with their indications and contraindications. The article provides information to help clinicians in decision making in order to provide individualized glycemic goals and appropriate therapy for patients with ESRD or earlier stages of CKD.

Original languageEnglish (US)
Pages (from-to)S22-S38
JournalAmerican Journal of Kidney Diseases
Issue number2 SUPPL.2
StatePublished - Feb 2014
Externally publishedYes


  • Chronic kidney disease (CKD)
  • diabetes mellitus
  • end-stage renal disease (ESRD)
  • hemoglobin A (HbA)
  • hyperglycemia

ASJC Scopus subject areas

  • Nephrology


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